Playing the numbers game
People in the UK are probably now familiar with the slogan "Five A Day", which is part of the Government's campaign to improve the health of the nation by getting the population to increase its consumption of fruit and vegetables.
People in the UK are probably now familiar with the slogan "Five A Day", which is part of the Government's campaign to improve the health of the nation by getting the population to increase its consumption of fruit and vegetables.
Recently the concept of five a day took on a different connotation when research carried out in India appeared to show that a single pill combining aspirin, a statin, an ACE inhibitor, a diuretic and a beta-blocker, as well as folic acid has the potential to halve the risk of cardiovascular disease in average, middle-aged people.
The trials, on more than 2,000 people with a risk factor, showed that the combined pill had the same effect as taking the drugs separately, but with no major side-effects.
Although further trials are needed to demonstrate that the so-called "polypill" actually does reduce mortality, there would seem to be several advantages to combining the ingredients into a single dosage form.
First, as the active ingredients are all relatively low-cost, the bill for treating a large proportion of the population would be fairly small. Second, the higher the number of separate medications to be taken each day, the lower the chances of patient compliance.
However, the benefits are not as clear-cut as they appear at first glance. It may be some time before the polypill reaches the market: as the active ingredients are all generics the profit margin is likely to be very low and there is therefore little incentive for Big Pharma to put resources into developing and testing it.
And then there is the ethical question of whether lifestyle should be medicalised. Is it right to prescribe medication for a condition that could be treated successfully through diet, exercise and giving up smoking?
The risk is that the polypill would come to be viewed as a substitute for, rather than an adjunct to, a healthier lifestyle. It may help to prevent cardiovascular disease, but it won't stop the development of arthritis or prevent the wide range of cancers associated with obesity, smoking or alcohol abuse.
Far from being a magic bullet, the polypill adopts more of a scattergun approach to medicine: aim it in the right direction and you are likely to hit some part of the target. Whether this is more effective in the long term than precise and accurate targeting has yet to be shown.